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Need some help…19 Rx drugs and not sure what to do

jack3454

Super Genius
229
I have a potential client who is turning 65 soon and wants a medigap. The issue is this person is on 19 Rx drugs, from pain meds, depression/anxiety meds, neuropathy, diabetes brand name drugs, migraine brand name drugs, bladder control drugs, sleep drugs, thyroid drugs, blood thinners, etc etc.

Not one plan covers all of the drugs (at most 15 of the 19), and the “cheapest” I can find is a $40/month AetnaPDP with an estimated $9,000 annual cost.

5 of the drugs alone come to $1,490 /month.

What would you do in this situation? Ive never dealt with so many Rx drugs before for one person. Thanks so much for any help.
 
I have a potential client who is turning 65 soon and wants a medigap. The issue is this person is on 19 Rx drugs, from pain meds, depression/anxiety meds, neuropathy, diabetes brand name drugs, migraine brand name drugs, bladder control drugs, sleep drugs, thyroid drugs, blood thinners, etc etc.

Not one plan covers all of the drugs (at most 15 of the 19), and the “cheapest” I can find is a $40/month AetnaPDP with an estimated $9,000 annual cost.

5 of the drugs alone come to $1,490 /month.

What would you do in this situation? Ive never dealt with so many Rx drugs before for one person. Thanks so much for any help.

You show him the lowest cost plan based on his specific medications. For the ones that aren't covered, look up prices on GoodRx and Singlecare. This person DEFINITELY needs to go with a Med Supp. This will be his only shot at one. And pain meds means monthly doctor visits to a pain management doctor.

Also, he'll get relief next year. At least for his meds that are covered.
 
I have a potential client who is turning 65 soon and wants a medigap. The issue is this person is on 19 Rx drugs, from pain meds, depression/anxiety meds, neuropathy, diabetes brand name drugs, migraine brand name drugs, bladder control drugs, sleep drugs, thyroid drugs, blood thinners, etc etc.

Not one plan covers all of the drugs (at most 15 of the 19), and the “cheapest” I can find is a $40/month AetnaPDP with an estimated $9,000 annual cost.

5 of the drugs alone come to $1,490 /month.

What would you do in this situation? Ive never dealt with so many Rx drugs before for one person. Thanks so much for any help.
I am not an agent.

I do not have to help clients with these issues.

I have seen agents on site discuss this program from time to time. I have no idea if it has the potential to help in your situation, just wanted to make you aware of it:

The thread below is a recent thread started by an agent wanting to use a Canadian pharmacy for some personal meds.


In regard to the posts there, I would just remark that @somarco is a long time Medigap agent with 100's of clients and a concern to help his clients with medication costs. He will have clients with hundreds, thousands, and maybe even 10's of thousands of dollars per year in medication costs. he puts his name and professional reputation on the line each time he makes recommendations like those to his clients. (as opposed to someone like me who only considers a few meds for themselves.)
 
I have a potential client who is turning 65 soon and wants a medigap. The issue is this person is on 19 Rx drugs, from pain meds, depression/anxiety meds, neuropathy, diabetes brand name drugs, migraine brand name drugs, bladder control drugs, sleep drugs, thyroid drugs, blood thinners, etc etc.

Not one plan covers all of the drugs (at most 15 of the 19), and the “cheapest” I can find is a $40/month AetnaPDP with an estimated $9,000 annual cost.

5 of the drugs alone come to $1,490 /month.

What would you do in this situation? Ive never dealt with so many Rx drugs before for one person. Thanks so much for any help.

I get a headache when someone has more than 10 drugs- i have a couple of times actually had someone over 25 drugs which is the limit formularies will calculate absolutely ridiculous someone is on so may many drugs..

In this situation i would get the medigap in the bag first to prevent them from canceling the whole shabang because they get mad at you for being the messenger of bad news about their drug cost. beyond the obvious of goodrx and Canadian pharmacies i would talk with them about asking their doctor about cheaper alternatives drug therapy.BTW i would be happy not be the the AOR responsible for part D enrolment like this.
 
"John, I found this plan. 14 of the Rx's you gave me are on their formulary. Here are the tiers: _____

Here is the summary of benefits for the plan - let's go over how it works.

(premium, ded, copay/coinsur... gap, cat)

For the remaining 5 Rx's - there are discount programs out there like GoodRx.

(Unsolicited Advice: Stop "estimating" their yearly)
 
I'd look at all the brand name and see the options. (If they are on Levemir, can they switch to Trulicity? Or whatever.)

Whats the effective date? $9K seems high in 2024.

Whats the current coverage? Can they delay til 2025? Or end of IEP?
 
"John, I found this plan. 14 of the Rx's you gave me are on their formulary. Here are the tiers: _____

Here is the summary of benefits for the plan - let's go over how it works.

(premium, ded, copay/coinsur... gap, cat)

For the remaining 5 Rx's - there are discount programs out there like GoodRx.

(Unsolicited Advice: Stop "estimating" their yearly)
werewolf0433_an_older_man_with_a_startled_look_on_his_face_hold_a15678c1-ab44-4d18-bb12-c388400ef2c8.png
 
Needymeds.com is a great source as well . It will have all the drug manufacturers assistance programs. You can print out forms to apply directly for help. They will usually have income guidelines etc.
That said it appears there must be a ton of drugs not on formularies for out of pocket to be $9000. If all drugs were on formulary max would be around $3750.
Leave all the cheap generics out and play with just the expensive ones . Then add generics back .
If there aren't options then it's time for client to have a sit down with their Doctor with current cost printouts.
Many Doctors have no clue on drug costs. Many Doctors don't care about cost unless you do.
 
"John, I found this plan. 14 of the Rx's you gave me are on their formulary. Here are the tiers: _____

Here is the summary of benefits for the plan - let's go over how it works.

(premium, ded, copay/coinsur... gap, cat)

For the remaining 5 Rx's - there are discount programs out there like GoodRx.

(Unsolicited Advice: Stop "estimating" their yearly)

Appreciate the advice. This will help a lot going forward.

I'd look at all the brand name and see the options. (If they are on Levemir, can they switch to Trulicity? Or whatever.)

Whats the effective date? $9K seems high in 2024.

Whats the current coverage? Can they delay til 2025? Or end of IEP?

Im going to dig deeper and see if any generics or switching is possible. Effective date is June 1. Yeah it does seem high, and that was the lowest!

We are enrolling her into a supplement plan. She cannot delay any longer, end of June is her last month of supplement enrollment period. Thanks for trying for any options.

Needymeds.com is a great source as well . It will have all the drug manufacturers assistance programs. You can print out forms to apply directly for help. They will usually have income guidelines etc.
That said it appears there must be a ton of drugs not on formularies for out of pocket to be $9000. If all drugs were on formulary max would be around $3750.
Leave all the cheap generics out and play with just the expensive ones . Then add generics back .
If there aren't options then it's time for client to have a sit down with their Doctor with current cost printouts.
Many Doctors have no clue on drug costs. Many Doctors don't care about cost unless you do.

Really good idea. And thanks for that site, it does look like a great resource!

I think at least 5 are not covered under any plan I saw, so that might be why. Ill do as you suggested and see if I can figure this out, or if she’ll need to sit down with her Dr with all these brand name drugs.

I mean dont they get a kickback for prescribing these brand name drugs? SHEESH this Dr is probably living in a mansion
 
You show him the lowest cost plan based on his specific medications. For the ones that aren't covered, look up prices on GoodRx and Singlecare. This person DEFINITELY needs to go with a Med Supp. This will be his only shot at one. And pain meds means monthly doctor visits to a pain management doctor.

Also, he'll get relief next year. At least for his meds that are covered.

Yep, we are enrolling them in a supplement G. It’s just the drugs that made me have a heart attack.

Thank you for the tips, I will try this.

I am not an agent.

I do not have to help clients with these issues.

I have seen agents on site discuss this program from time to time. I have no idea if it has the potential to help in your situation, just wanted to make you aware of it:

The thread below is a recent thread started by an agent wanting to use a Canadian pharmacy for some personal meds.


In regard to the posts there, I would just remark that @somarco is a long time Medigap agent with 100's of clients and a concern to help his clients with medication costs. He will have clients with hundreds, thousands, and maybe even 10's of thousands of dollars per year in medication costs. he puts his name and professional reputation on the line each time he makes recommendations like those to his clients. (as opposed to someone like me who only considers a few meds for themselves.)

Appreciate the help here. Lots of great information to read. Thanks!

I get a headache when someone has more than 10 drugs- i have a couple of times actually had someone over 25 drugs which is the limit formularies will calculate absolutely ridiculous someone is on so may many drugs..

In this situation i would get the medigap in the bag first to prevent them from canceling the whole shabang because they get mad at you for being the messenger of bad news about their drug cost. beyond the obvious of goodrx and Canadian pharmacies i would talk with them about asking their doctor about cheaper alternatives drug therapy.BTW i would be happy not be the the AOR responsible for part D enrolment like this.

Yeah, having this many drugs really hurts my heard sometimes But I need to remember Im better off trying to help someone with this many drugs, than be on a lot of drugs myself. This person actually told me no one else would help, so I feel like Im destined to help this person now. Also, yes we are doing the Supplement enrollment very soon while I figure out these drugs!

Thanks for the advice!
 
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